For clinics
The billing office stops fighting denials — it starts preventing them.
Three familiar scenarios
The bounced registry. The payer denied part of the lines; finding out why takes weeks of correspondence, resubmission, frozen revenue.
The dispute by letter. The expert requests source paperwork; the billing office assembles copies, the physician is pulled away from visits, and the outcome depends on whose reconstruction sounds more convincing.
Note vs claim mismatch. A service is billed with no trace in the note — or the other way around: care was delivered, but the line got lost on its way to the accounting system.
What changes
- Every claim line has a lineage. Document → fragment → term → vocabulary descriptor → code → tariff → claim; a version and an author at every link. Disputes are resolved by presenting the chain, and the evidence is available on request.
- Disputes resolved before submission. Lines without a reliable binding never enter the act silently — they are worked on the act panel before the claim goes out.
- Denials worked in minutes. For every denied line the reason, the chain and the decision history are already assembled; the specialist chooses: contest, correct, write off.
- Medical and economic documents consistent by construction. The note and the act derive from the same set of authorized terms — a mismatch is constructively impossible, not “detected on inspection”.
How it deploys
Two deployment models:
| Model | For whom | Data |
|---|---|---|
| Inside the clinic’s perimeter | public organizations and anyone requiring full contour control | never leave the clinic’s infrastructure; the reconciliation panel is the exception, see below |
| Managed service | private clinics and chains without their own infrastructure | processed in the protected HealthOS cloud in Russia |
The reconciliation panel runs only in the managed service. Two organizations working together need an instance shared between them, and an instance inside one party’s contour cannot be shared: the other party will not enter it, and the non-repudiable reconciliation log would become a record kept by its opponent. Instances are separated and isolated per tenant; the clinic and the payer are given a shared tenant.
Hence, for a clinic with its own contour: the pipeline and the clinic’s own panels run inside its perimeter, while reconciliation with the payer runs in a shared cloud tenant. This means that the grounding fragments of disputed lines do leave the clinic’s infrastructure — in the scope of a single disputed line, to the parties of that dispute, and on the record (see regulatory information). Nothing else leaves the perimeter.
Connection — via the web workspace, integration with the clinic’s information system, or a standard export to the accounting system; no system replacement required.
Where to start
The Basic service (pipeline and binding panel) and the Billing service (plus the act and dispute panels, API integration) — service details. The first step is a short pilot on your de-identified documents with a before/after measurement: denial rate, dispute handling time, automatic-binding share.
Estimate the scale of your losses — or start with a pilot.